First time shoulder pain

Discussion in 'Health & Fitness' started by topsltennis, Jun 18, 2012.

  1. topsltennis

    topsltennis Semi-Pro

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    Over the many years I've been playing tennis I have had bouts with elbow and wrist problems, but never a shoulder. In the last few days I have having some pain;tenderness in the front of the shoulder, it's not horrible pain, and so far doesn't really hurt much when I play. Pain is worst if I extend arm out to the side and then pull arm back. That is actually pretty painful and tender. Any ideas? Is this rotatar cuff or something else?
     
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  2. limitup

    limitup Professional

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    Could be a random thing that disappears in a few days, but most likely it's the beginning of some kind of impingement in the rotator cuff...

    Hard to say which muscle it is though as they all kind of come together in that area. If it's clearly in the front, it's most likely the subscapularis. If it's the side/front it's most likely the supraspinatus. If it's mostly the side it could be the supra or the infraspinatus which kind of comes from the back and wraps around the side.

    I'm going through the same thing and mine isn't responding as well as we would like to the standard rehab protocols. Part of the problem is that I'm a side sleeper and I smash my shoulder half the night. I'm in the process of training myself to sleep on my back, which they say will help it be able to actually heal.

    Your best bet is to go see a good physio and do some PT. It might go away if you rest it, but even if it does you'll still have the same problem that caused it to happen in the first place (various muscle imbalances, one or more weak muscles, bad positioning of the shoulder due to bad posture, etc. etc.)

    In the meantime, definitely no pushups, pullups or anything else that makes it hurt. I made my problem worse, or maybe even caused the problem, by doing massive amounts of both with bad posture due to sitting at a desk too much.
     
    Last edited: Jun 18, 2012
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  3. topsltennis

    topsltennis Semi-Pro

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    hey thanks for the insightful reply........ on top of the shoulder I am having knee issues with my right knee, I have had problems many times with the left knee before, but usually not the right- appears to be the same issue, 'jumpers knee', though being a righty, it's always been the left so maybe it's something else........the shoulder is slightly concerning given I've never had this issue before, it definitley is the front/inside part
     
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  4. limitup

    limitup Professional

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    Funny - I'm dealing with a knee issue as well. Might be an IT band issue or even a hamstring tendon issue ... no one knows for sure. MRI shows nothing but it's been giving me problems off and on for months.

    I've tried just about everything. 2 months of no tennis did nothing for it. 2 months of PT while continuing to play a little less tennis than usual helped a good bit, but it still gets sore every other day it seems. There's no pain whatsoever while playing, so doc and physio both say to keep playing.

    I've been stretching and rolling the IT band for the past week or so and that's seems to help so who knows. I always have patella pain in the front every now and then, but everyone thinks that is a secondary issue. The patella strap does help a lot overall though.
     
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  5. topsltennis

    topsltennis Semi-Pro

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    I always just power through this stuff and eventually it goes away, I hit everyday and therefore inevitably I'm going to have some issues. I just turned 43 and have yet to have anything bad enough to sideline me and I've been playing since a junior. Eventually something will get me probably. I definitley have muscle imbalance issues as well- all I do is play tennis, i hit a one hand backhand and was told a few years ago when I saw a sports med doc about a sports hernia that a lot of my problems are due to muscle imbalance.
     
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  6. Fee

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    Speaking from experience, don't ignore this. I had a 'twinge' in my shoulder last year and I ignored it for a few months until it became a nagging pain. I'm still trying to resolve this issue and could be looking at surgery. If you have health insurance, get to a doctor and at least get an xray. Good luck.

    (my diagnosis: bicep tendonitis, which somehow led to bursitis and a localized rotator cuff strain and now impingement that causes pain in my neck and head when I move my arm. Hooray!)
     
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  7. Bobby Jr

    Bobby Jr Legend

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    That there is probably one of the most common shoulder injuries in tennis players. It starts with the bicep and before you know it you've cause a shoulder injury.
     
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  8. topsltennis

    topsltennis Semi-Pro

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    No health insurance here. It's weird that for the most part, other than occasional above shoulder shots and early serves in the hitting sessions, tennis isn't that much of an issue (knee is much more noticeable). It's more noticeable off the court doing certain tasks (like pouring my wine!)
     
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  9. hcb0804

    hcb0804 Hall of Fame

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    Rest until it goes away man, trust me. I had similar symptoms, and kept playing......result: tore the labrum, also known as SLAP tear, major surgery, long painful rehab, and my shoulder has never been the same. Almost two years out from surgery and rehab, I am still really struggling with pain and I have lost a huge amount of MPH on my serve. Ice, rest, get PT and strengthen it now before it's too late.
     
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  10. topsltennis

    topsltennis Semi-Pro

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    I'm going to see what happens over the next few days; I have gone through so many things like this over the years and to date nothing has gotten to the point that didn't eventually take care of itself. I usually chalk it up to tendonitis due to the amount and frequency that I play. I'm going to keep a close eye on this and my knee, both are a bit worriesome.
     
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  11. limitup

    limitup Professional

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    Forgot to comment on this. It can be caused by a lot of stopping and starting and side to side movement which we all have to do on the court, but I think serving contributes to it as well. That's why righties seem to get it more often in their left knee and vice versa. You push off of and land on that leg 1000s and 1000s of times over and over when you serve. It's the same reason that righties usually have a much bigger calf on their left leg lol (unless they purposely do extra work in the gym for just their right calf to compensate)
     
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  12. Pacific lefty

    Pacific lefty Rookie

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    I would be very careful to have this checked out and not to play if there is any pain! If you have seen any of my threads regarding shoulder impingement/tendonitis, it can become a very slow healing, tennis destroying problem. I am just getting full movement back in my arm 7.5 weeks after decompression surgery and I haven't played proper tennis since November. I played right handed for a while, and didn't want to admit it, but it still aggravated the injured left shoulder.
     
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  13. Fee

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    I wasn't even playing tennis at the time. I had to stop 3 months before because my lower back was getting irritated.
     
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  14. Chas Tennis

    Chas Tennis Hall of Fame

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    Your injury very likely might not be impingement. Who knows?

    This Todd Ellenbecker video has a lot of information about the shoulder anatomy, motions, injuries, and especially impingement. The comments about how to hold the proper arm orientation to minimize the risk of impingement on the serve and overhead start at minute 8. You need to be crystal clear on what he is saying to minimize the risk. You need video to see what you are doing regarding your shoulder orientation. Most of his exercises and stretches are for healthy shoulders to prevent injury not for rehab. Once injured they might cause problems.

    http://www.tennisresources.com/index.cfm?area=video_detail&vidid=3712&ATT=&reso=hi

    You should see a Dr if possible and certainly stop the activity that caused your injury and other motions that aggravate it.

    For knee and shoulder issues search posture + knee, etc. on this forum. There have been several informative threads.
     
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  15. limitup

    limitup Professional

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    Chas Tennis - can you expand on what you said above re: knee and shoulder issues? Are you saying they are related? And related to posture? Well obviously bad posture can lead to shoulder issues and impingement, etc. but is that somehow related to your knees too? I'm working on it but I still have "bad" posture, a left shoulder issue, and also a left knee issue so your post caught my eye.

    When you say search posture + knee do you mean to type in "posture + knee" exactly like that into the search box? I'm VERY interested in locating these threads you refer to. Thanks!
     
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  16. Chas Tennis

    Chas Tennis Hall of Fame

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    I don't have much formal background except two college courses on physical fitness and exercise and a lot of reading.

    From what I have read I subscribe to the view that posture can be very important to long-term joint health. Some think predominately in terms of age or overuse or heredity or stressing when injured, etc. but posture belongs in that list of significant causes. Worse, viewing it as just age misses possible corrections that might result from correcting posture. Posture might be one of the more important things to consider since you can do something about it, unlike some of the other causes like age.

    The simplest example to visualize is the spine with a stack of vertebrae (described in one article as an aligned stack of pancakes). If the spine is misaligned so that one side of a vertebra gets too much stress then that area might be injured especially in athletics. Its not as easy to visualize the knee or shoulder.

    First, all posture is from head to toe. But there are some very close associations. For the knee, the hip and pelvis determine a lot of the knee posture. Tight, loose or weak muscles in the hip especially can set the knee up for trouble.

    Also, imbalances among the quad muscles can set the knee cap up for poor tracking, pain on bending the knee. These are complex subjects and require professional evaluations. If you stretch a muscle that is fine it might make a condition worse.

    I had a torn rotator cuff from gym work(not my dominant tennis shoulder). In the treatment of that injury, the physical therapist told me that they treat baseball pitchers by evaluation the shoulder posture - mostly scapular posture - and correcting weak muscles with strengthening and tight areas with stretches. I became a believer from that experience. When I look at Maria Sharapova I can see that her shoulders come a little too far forward probably from the well known imbalance of overdeveloped front muscles, pecs, etc. Again the shoulder is very complex and needs professional evaluation, certainly so if injured.

    I think it is very important to know the proper terms for the joint movements otherwise misunderstandings occur. For example, look down at your knee and rotate it. That's not knee rotation its hip rotation! As a reference I like the Manual of Structural Kinesiology, C. Thomson. Get an older edition such as the 15th as it is much cheaper than the current one used as a college text. est. $20 used? Anatomy reference also.

    In this Tennis Warehouse Health & Fitness Forum, "SEARCH" box above, use any 4 or 5 of these terms together to find the threads. Several in the last 6 months.

    knee posture knee pain patellarfemoral Posture Guy Chas Tennis Charliefedererer shoulder posture Blackburn exercises impingement
    Eric Cressey tight rectus femorus


    Put in your own words - pain under knee cap, etc. I don't think that the order of the words is important. Use quotes "Eric Cressey" to limit the number of finds more specifically?

    I would not accept any conclusions or information from the internet especially from forums but use it to start researching the problem. There are, however, a lot of very interested people finding great information.

    Eric Cressey has a lot to say on posture issues. Johns Hopkins Sports Clinic list.
     
    Last edited: Jun 19, 2012
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  17. limitup

    limitup Professional

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    Thanks Chas. I'm a big believer in the importance of posture as well. I had horrible posture when I started playing serious tennis about 8 months ago, due to many years hunched over a computer. For me it resulted primarily in chronic lower back pain, and as I increased my court time even a little I found I couldn't really play competitively any more because my serve was affected so negatively, and it was a big weapon for me.

    Then Posture Guy reminded me about Egoscue, and long story short 8 months here I am with a straighter body and a bulletproof back, and play more competitive tennis than ever.

    So now I'm dealing with a chronic knee issue. MRI showed nothing significant, and it feels fine when I play tennis, it's just sore and it aches a lot when I'm not playing. Still can't figure out if it's a tight IT band, tight quads, a hamstring tendon issue, or something else. Even the stuff the PT had me do hasn't eliminated it completely after about 2 months, so I'm just going to hit it from all sides and address all those things.

    Lately my shoulder has been giving me problems too. Just like the knee it's fine playing tennis - even serving - but there's definitely an impingement. Saw the PT again for this and am doing all the recommended strengthening and stretching for this too now. I think I actually caused this myself by doing a ton of pushups and pullups with my crappy rounded shoulders.

    I've worked on a computer for 10+ years now and the more I learn the more I understand how bad it is for you. Not just for your posture, but for your entire body in general. But I've always had a hard time being comfortable with "good" posture, and my shoulders are rounded forward big time.

    They're slowly moving back and getting better now than I'm doing the Egoscue and other stuff I'm doing, but it's going to take awhile. Until then I'm laying off all pushups, pullups, and anything else that aggravates my shoulders. Fortunately tennis and serving isn't one of them!

    Well I'm rambling now, but I'm definitely interested in all this "stuff" and learning as much as I can. My off-court fitness is based entirely on tennis specific exercises, bodyweight stuff, Egoscue exercises to keep my body "straight" and functional form head to toe, and a lot of focus on a lot of the little but important muscles that get forgotten or ignored by most people.

    Thanks to everyone who has and continues to provide info on this and other related topics so we can all continue learning...
     
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  18. Rjtennis

    Rjtennis Hall of Fame

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    What your describing sounds like burcitis or bicep tendonitis if it is in the front of the shoulder. Can you feel it when you push your elbow inward towards your chest? Burcitis is not going to lead to any long term shoulder damage, but it is really painful. I see an ortho, do some exercises and get cortizone injections every 9 months to treat mine. That seems to be working so far for me. If it persists I would go see an orthopedic.
     
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  19. limitup

    limitup Professional

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    I'll tell you what hurts mine the most ...

    Standard up with my arms hanging down by my side, and rotating my hand and forearm inward as far as it will go.

    On the good side there's a stretch and I just can't go past a certain point, but there is no pain. On the "bad" side it hurts like hell once I get near the limit lol
     
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  20. Chas Tennis

    Chas Tennis Hall of Fame

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    Here is one of the threads that I referred to

    http://tt.tennis-warehouse.com/showthread.php?t=425152

    See my reply #11.

    In particular, I have found this stretch useful for my tight rectus femorus.

    http://www.mrtherapy.com/articles/article3.html

    However, be warned that stretches of the hip flexors might injury the lower back in some people.


    You don't mention where you knee pain is, under knee cap, etc. ?
     
    Last edited: Jun 19, 2012
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  21. Chas Tennis

    Chas Tennis Hall of Fame

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    Peak Performance Fitness, Jennifer Rhodes

    One of the references that I found very useful for a variety of posture issues is

    Peak Performance Fitness, Jennifer Rhodes

    She discusses several common problems of the body that are posture related. The descriptions are very clear and well illustrated. The muscles and bones are identified and the problems caused by poor posture are illustrated. Stretches and exercises to correct are given.

    Regarding sitting at the computer, I believe that the abs are held too short for too many hours. They are also held short for watching TV while slouching and sleeping on one's side. Tennis also because I'm bent at the waist. That shortened ab position tends to give the front of the chest the shortened, slouched look with the head and shoulders forward. Appropiately, the super nerd look, seen on comedy TV shows, with the belt way high and the abs held very short, fits the reality perfectly. One book that discusses the issue and calls it the "collapsed posture" is

    Pain-Free Living, by Craig Williamson.

    Sometimes when I'm driving I tell myself to completely relax my abs from their normal tenseness. My head can go back against the head rest. Sometimes I try this in bed while sleeping on my side and have on occasion bumped my head and shoulders into my wife.

    For me, the abs control the position of my head and shoulders much more effectively than trying to use muscle power. For example, some references suggest to 'put your shoulder blades into your back pockets' using muscle power. Using muscle power to reposition joints for me has always had the same result - fatigue in a short time. I believe more that my life style has shortened certain muscles & tendons and that I need to stretch them.
     
    Last edited: Jun 23, 2012
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  22. Chas Tennis

    Chas Tennis Hall of Fame

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    Any injury has to be properly diagnosed and any necessary physical therapy properly supervised so that it is done correctly. Stretches or exercises with an undiagnosed injury might cause farther injury.

    I'm not qualified in this subject but did have physical therapy for a torn rotator cuff. I have not gone over this in detail but the stretches and exercises are those that I would expect are in many rehabs for injuries like mine and with my diagnosed deficiencies. I still do the Blackburn exercises with light weights or pulleys to 50 reps. The idea is to train endurance on selected smaller shoulder muscles, especially those that position and stabilize the scapula.

    http://www.ioshospital.com/orthopae...bility/nonoperativeThrowersRehabilitation.pdf

    I believe that when injured I had shoulder pain while sleeping from ischemia or lack of blood flow. Getting up and moving around would stop it.
     
    Last edited: Jun 19, 2012
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  23. hcb0804

    hcb0804 Hall of Fame

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    Not wise. Forewarned is forearmed. Good luck with that.
     
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  24. topsltennis

    topsltennis Semi-Pro

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    Pain seems to have worsened just a bit, but nothing too terribly bad. Started icing after hitting a couple of days ago. Still bothers me most doing off court things vs. actually hitting the ball. High backhands (one hander) and serves hurt the most on court. Talked with another local pro; he thinks it's likely just inflammation vs. any kind of tear at this point; said if there was a tear I likely would not be able to continue playing.
     
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  25. limitup

    limitup Professional

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    Not sure why you're ignoring everyone's advice but good luck man. You'll need it if you keep ignoring the problem!
     
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  26. topsltennis

    topsltennis Semi-Pro

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    Not ignoring, appreciate the advice, but I've been through numerous bouts of tendonitis in the wrist, elbow, etc. and have always been able to keep playing. I am a little concerned since it's a shoulder and I've never had that issue before, but as long as it doesn't get much worse I'm going to try and treat with ice/ anti inflammatory meds.
     
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  27. limitup

    limitup Professional

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    An impingement in the shoulder (most likely what you have) is NOTHING like tendonitis in the elbow or knee...
     
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  28. topsltennis

    topsltennis Semi-Pro

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    ok, going to do some more research, thanks
     
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  29. limitup

    limitup Professional

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    The thing is, they are totally different and so are the treatments. For tendonitis, R-I-C-E is generally all you need (although there are sometimes other things you can do to help i.e. address muscle imbalances, tightness, etc.) If you have some kind of impingement in your shoulder, R-I-C-E is NOT the appropriate treatment.
     
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  30. topsltennis

    topsltennis Semi-Pro

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    What would be the treatment then?
     
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  31. Pacific lefty

    Pacific lefty Rookie

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    I strained my shoulder rc in October of 2010 and for over a year tried all sorts of PT and cortisone injections, anti-inflammatories, icing, etc to no avail. By far the worst thing I did was to try and play through it. I had the subacromial decompression surgery/acromioplasty 8 weeks ago now and am still doing PT, trying to get ready to go back to hitting groundstrokes.

    I think impingement should be conservatively treated, if it is possible, and under the recommendation of your specialist. This is because rehab, even for a surgery with no rc tear or repair, is a major committment, and patience and time are paramount in healing the injury. However, I felt like it got to a point where a year and a half passed and none of these conservative approaches helped.

    Chas Tennis, did you treat your rc tear uniquely through PT. Any links to your exercises for building rotator cuff endurance? My goals is to try and play the winter league here in November which would be 7 months post surgery,requiring me to play two doubles matches in a row (which was easy pre-injury but sounds impossible now)...
     
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  32. Chas Tennis

    Chas Tennis Hall of Fame

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    my non-tennis shoulder experience

    My rotator cuff injury was of my non-tennis shoulder. THIS TREATMENT FOLLOWED A LIKELY DIAGNOSIS THAT WAS BACKED BY AN MRI. Mild tears of the supraspinatus. The first Dr said no surgery was necessary and wanted to give me a cortisone shot which I don't believe in. I wanted a second opinion. The second Dr said the same and also wanted to give me a cortisone shot. At that point, I asked about the physical therapy approach. Reluctantly, he prescribed some physical therapy. This was not the ideal scenario with the Drs that I had hoped for.

    The physical therapist evaluated my posture and shoulder posture and found some issues mainly involving the scapular positioning. He was completely open and explained what he found and why he was doing the exercises and stretches. He also explained something that I had asked both Drs about and received no answer - why would I get pain when I tried to sleep and could not get comfortable changing positions? He said that it might be ischemia or pain from lack of blood flow. I believe that he was correct because if I got up and moved around to better circulate my blood, the pain stopped. He had me do light exercises for endurance to tighten up certain muscles (the scapula has many muscles connected to it from all angles.) The exercises included Blackburn exercises. Reply #22. But these were tailored for my shoulder issues and they are fatiguing and somewhat stressful for some small RC muscles. During the physical therapy I would say that I was not in much pain. 6 years later my shoulder is not perfect but OK, little discomfort on heavier lifting, little less strength, pain free 90% of the year.

    I might add that while I had a rotator cuff injury, I'm not sure that impingement was the cause. My cousin's husband got angry and threw a trash can - complete supraspinatus rupture. I think that I hurt mine in the gym, not that much sudden pain but discomfort at first and a clear loss of strength.

    In your case, you have a post-operative shoulder and probably some of the debris from the operation is still there, swollen bursa sacks?, edemas?, misc grit? ........?.......... . It might take a long time for your body to clear or reform some of that stuff. Has your Dr identified anything specific that is the slowest to heal? Anything about bursa sacks? Any bursa sacks removed?

    Dates & Goals. Decide not to play for two years........................................................ Then, if you are pain free and find it easy to get in condition and find yourself saying 'its really stupid to not be playing' for a month or two, reconsider. Review that Ellenbecker video on the shoulder and its position on the serve. First thing do videos of your serve & other stroke techniques. I would be very careful selecting a tennis instructor. I'd have to have confidence that he/she has knowledge in the subject material in the Ellenbecker video and has experience in teaching players with shoulder injuries. They would have to use high speed video to know exactly what you are doing.
     
    Last edited: Jun 24, 2012
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  33. Pacific lefty

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    Thanks Chas, the Ellenbecker video is really good and makes a lot of sense. I have seen the other Pat Dougherty serving video as well. Not so easy to find a clued-in pro here in south of Ireland but will definitely ask around.

    I did have a bursectomy at the time of the procedure and my surgeon said he was confident that there will be plenty of room for the tendons to move around. However on his report he did identify that the supraspinatus was still inflamed, so I don't know what the resolution is supposed to be for that. My PT seems to think that even though the inflammation is there, it will not have any negative effect as there will be room for it to move freely.

    Never thought of the implications of debris but there is definite residual pain at night, from the minute I lie down to start reading and still notice it first thing when I wake up. Sounds a bit like the ischemia you were talking about...
     
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  34. Chas Tennis

    Chas Tennis Hall of Fame

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    I have read that the function of bursa sacks is to lubricate, separate and cushion mostly, I guess, adjacent tendons but maybe also other structures, bones or ligaments, etc. ? The body has evolved to place bursa sacks where two tendons (or other structures) would otherwise have rubbed together. The Atlas of Human Anatomy shows several bursa sacks in the shoulder, including the Subacromial Bursa and the Supraspinatus M. Bursa.

    One of my friends had a very enlarged, distorted and unsightly bursa sack on his elbow. It had excess fluid but did not cause pain or bother his tennis that much. He had it removed and has had no functional issues that I know of. You can ask your Dr about your shoulder.

    The supraspinatus inflammation that you mention, was that observed only during the surgery? Has the Dr said that it is still there? I don't know the requirements for physical therapists elsewhere but in the US they are medically trained, perhaps specializing for two years. ? The three physical therapists that I have dealt with were closely associated with the hospital's sports medicine clinics, very knowledgeable and experienced. They would help me with the physical therapy and I would see the Dr for a followup visit. Also, I believe that the physical therapist dealt frequently with the Dr and would have reported any issues to the Dr, but I'm not certain. If I had had questions about the progress I would have called the Dr.

    I don't know what would cause ischemia for these shoulder injuries but I had no shoulder surgery and believe that I had ischemia. There was no Dr's diagnosis. I guess any swelling might restrict blood flow. ? What has your Dr had to say on the night pain?
     
    Last edited: Jun 25, 2012
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  35. Chas Tennis

    Chas Tennis Hall of Fame

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    This simple description of common shoulder injuries includes pain on "the front of the shoulder". For Pacific Lefty, it also describes bursitis and impingement.

    http://sportsmedicine.about.com/cs/shoulder/a/shoulder4.htm
     
    Last edited: Jun 25, 2012
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